Calendar Year  IT EF OPT OUT  
                                                                                                          Rev. 8/18 
           I ~.e:.~~:ent        of                IIIII I II 1111111111111111             1 1 1 1 1 
                                                             10211411  

                                Preparer Request for Exclusion from 
                  Electronic Filing Requirement for Personal Income Tax  

This completed form is a request to be excluded from the requirement to transmit tax returns electronically as 
outlined in Ohio Revised Code section 5747.082. Required tax preparer information and reasons supporting the 
request must be outlined below.  

Please complete all questions on this form to prevent your request from being returned as incomplete and denied.  

1.Name of your tax preparation business  

2.Contact person name and phone number  

3.Business address  

4.Preparer’s PTIN (if self employed, enter your SSN)    

5.Enter your EIN  

6.How many original returns did you or your firm   prepare last calendar year?             

7.Outline in detail the reasons for this request  

Firm or tax preparer responsible party                                                    Date  

                    For tax department use only. Do not complete information below this line.  

Tax Commissioner – Approved / Denied                                                      Date  

Notes  

Please mail this form (completed in its entirety) to:  Ohio Department of Taxation  
                                                             Electronic Filing Unit  
                                                             P.O. Box 2476  
                                                             Columbus, OH 43216-2476  

                                         Federal Privacy Act Notice  
 Because we require you to provide us with a Social Security number, the Federal Privacy Act of 1974  requires us to inform you that 
 providing us with your Social Security number is mandatory. Ohio Revised Code sections 5703.05, 5703.057 and 5747.08 authorize   
 us to request this information. We need your Social Security number in order to administer this tax.